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Peds Fall 2020 > Lecture 5 > Flashcards

Lecture 5 Flashcards

1
Q

What saccade test is good for baseline in sports/concussions

A

KD

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2
Q

Describe KD test

A

First pt looks at numbers connected by solid lines. Horizontal

Then pt looks at numbers with no connected lines. A little harder. Horizontal.

Then pt looks at numbers with no connected lines and squished together.

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3
Q

How to grade KD tests

A

Check average time and average errors by age for test 1, 2, and 3. Then find the Z score and compare to percentile rank table.

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4
Q

How to calculate Z score

A

Actual-mean
__________
Standard deviation

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5
Q

What happens if the child’s time on the KD test is greater than the mean?

A

Then use the negative Z score when looking at the percentile rank table

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6
Q

What happens if the child’s time on the KD test is less than the mean?

A

Use positive Z score when looking at the percentile rank table

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7
Q

DEM test what does it look like

A

A and B are vertical

C is horizontal and squished.

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8
Q

How to score DEM

A

Convert these to Z scores:
total vertical time. Add A and B together
Horizontal time (adjusted for omissions and additions)
Errors
Ratio of horizontal adjusted time/vertical

Compare time to the age based table.

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9
Q

Ages that can do DEM

A

6-14

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10
Q

How to calculate horizontal time adjusted

A

Adjusted time= time x 80/80 - omissions + add

80 is the amount of numbers in test
time is how long it took child to read.

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11
Q

How to calculate ratio for DEM

A

Adjusted horizontal/vertical

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12
Q

Type 1 DEM
Vertical:
Horizontal:
Ratio:

A

Normal
Normal
Normal

Results: Normal

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13
Q

Type II DEM
Vertical:
Horizontal:
Ratio:

A

Normal
High- slower than avg
Abnormal- high

Result: Ocular motor disfunction.

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14
Q

Type III DEM
Vertical:
Horizontal:
Ratio:

A

High
High
Normal

Result: RAN problem. Rapid automatic naming.

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15
Q

Type IV DEM
Vertical:
Horizontal:
Ratio:

A

High
High
Abnormal

OMD/RAN problem

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16
Q

How to treat OMD

A

VT

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17
Q

How to treat RAN

A

Speech language therapy

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18
Q

What is the readalyzer

A

Computer program that records eye movements while pt reads passage. Comprehension is tested. Compares variables to grade level norms.

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19
Q

What does the reanalyzer show

A 
Fixation
Regressions
Fixation duration
Reading rate 
Grade level 
Correct comprehensive answers
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20
Q

Right eye test

A

Eye tracking without goggles. Readout of saccades and pursuits. Diagnostic and therapeutic.

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21
Q

3 big picture methods for saccadic testing

A

Paper: DEM, KD
Computer: reanalyzer, right eye
Chairside: NSUCO/maples

22
Q

Static ret

A

Control accommodation by cyclo, fog, distance fixation to determine distance ret

23
Q

Dynamic ret

A

Dose not control accommodation. Purpose is to determine near rx

24
Q

What percentage of cyclo to use on infants and then kids 12 months plus

A

Infants: 0.5%
12 moths +: 1%

Use loose lenses or skiascopy bars

25
Q

Mohindra near ret

A

A near ret technique for assessment of distance refractive error. Static even tho not fixating in distance.

26
Q

Mohindra near ret technique

A

Dark room without ambient light so pt will only look at ret light
Infant fixates at ret 50cm
Use skiascopy bars
subtract -1.25D from result

27
Q

Toddler/preschool ret and phoropter

A

Use interesting fixation target- movie maybe
Pt will be too small for phoropter- do trial frame.
Do not do JCC

28
Q

At what age can you use phoropter and JCC

A

school age. 8+

29
Q

Normal refractive error for full term newborns

A

On average, +2.00

88% between plano and +4.00
Standard dev of 2.75

30
Q

Emmetropization

A

Tendency for the refractive state of the eye to change close to plano. Converges to low hyperopia (+0.50 to -1.00 with S.D of +/- 1.00)

31
Q

Refractive error trend

A

Skewed towards hyperopia

32
Q

Active emmetropization

A

Regulated by regnal image- eye interprets retinal blur and adjusts by changing axial length. Lets longer for myopes, shorter for hyperopes.

33
Q

passive emmetropization

A

Occurs as a result of physical/genetic changes.

physical: refractive errors move to emmetropia initially.
Genetics:
-Both parents myopia 42%
-1 parent myopia 23%
-Neither myopia 8%

Other: Changes in corneal/lenticular power.

NO active growth changes.

34
Q

Emmetropization structural changes

A

Cyrsalline lens: Thins in infancy and early school years
Corneal power decreases
Axial growth

35
Q

Berkely infant biometry study (BIBS)

What was their finding?

A

Emmetropization (plano to +2.00D) within 3-9 months.
Bidirectional.
Myopes will become more plus
Hyperopes will become more minus

Best predictor: Cyclo refraction

36
Q

1.00D or more of cyl in __% of newborns

A

30%

Highest in first 2 years, adult levels by 4-5 years.
Will decrease!

37
Q

If little astigmatisms in 1st year of life you can predict

A

That they will likely not develop any

38
Q

Trend of ATR and WTR astigmatisms in infants

A

ATR has steady decline

WTR has uptick around 1 year and then steady decline

39
Q

After age 5, what kind of astigmatism is most common?

A

WTR

40
Q

Multi ethnic pediatric eye disease study (MEPEDS)

A

Looks at astigmatism in children ages 6-72 months
Greater than 1.50 DC= 16.8% hispanic
Greater than 3.00 DC= 2.9% hispanic
Most WTF, decreases with age

41
Q

Lowest prevalence of myopia is in ___ year olds

A

5-7 year olds.

42
Q

5-6 year olds with plano to +0.25 D likely to become

A

Myopic by teenage years. Females earlier than males.

43
Q

Refractive error changes faster in children with ___ than ___

A

Myopia than hyperopia

44
Q

Accommodation. How does it work

A

Ciliary muscles contract (stand up) and zonules relax. The lens becomes rounder/more convex

45
Q

Development of accommodation

A

Occurs between ages 1-3 months, then adult like.

46
Q

Infants under 3 months old, they tend to over accommodate.

Due to?

A

Target proximity
Large depth of field- very small pupils
Poor sympathetic innervation to ciliary muscle- to relax accommodation. q

47
Q

How to test accommodation in infants/toddlers/preschoolers

A

Near ret

48
Q

How to test accom in school age and beyond

A

Amp of accommodation (monocular)

  • Push up
  • Pull away
  • Minus lens test

FCC testing
Near Ret
NRA/PRA

Done wearing correction!!

49
Q

Minus lens procedure to measure accom

A

Done in phoropter
use 1 line above best VA at 40cm.
Add minus lenses until pt reports first slight sustained blur- not blur out.

With young children, start with -3.00D over Rx since they have a large amount of accommodation. Take diff from Rx until blur then subtract working distance.

50
Q

Hofstetter’s norms

A

Average amp calculation: 18.5- (1/3)(age)

Minimum amp calculation: 15 -(1/4)(age) ** Sweedish study says subtract 2 from this and that it is an over estimation.

Peds Fall 2020 (15 decks)

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